FIRST PASSENGER INFORMATION

* Input is required

Gender : * Male    Female
First Name : *
Middle Name :
Last Name : *
Reservation # for existing reservations :
Address : *
Address 2 :
City : *
State/Province : *

Select N/A for non US/Canadian passengers
Postal/Zip Code : *
Country : *
Citizenship : *
Loyalty Member Number :
Birthday : *
Home Phone : *
Cell Phone :
E-Mail : *
Nicknames, if applicable :

SECOND PASSENGER INFORMATION

Leave blank if traveling alone. Indicate below if you would like us to arrange a "Share"

Gender : Male    Female
First Name :
Middle Name :
Last Name :
Address :
Address 2 :
City :
State/Province :

Select N/A for non US/Canadian passengers
Postal/Zip Code :
Country :
Citizenship :
Loyalty Member Number :
Birthday :
Home Phone :
Cell Phone :
E-Mail :

DINING REQUEST : * I would like to request : Early Dining    Late Dining    Flexible
Small Table    Large Table
CRUISE/TOUR INFORMATION
I wish to sail/travel on : *
Ship/Tour Cabin/Room Information : * (Double occupancy) -- Category @ USD pp I would like a single cabin/room in Category :
I am traveling alone, please arrange “Share” in Category :
Please waitlist me/us for Category :
You will not be charged to be put on the waitlist. Should space open up, then you will be charged. You can email us to be removed from waitlist to reservations@mimktg.com
Please tell us if we should know anything about you, including dietary needs, etc.
TRAVEL INSURANCE : *
Available for US residents.
Yes, please contact me with information regarding travel insurance    No, I will not be requiring travel insurance

PAYMENT INFORMATION
I am paying by credit card.
(My credit card will be billed first deposit (or first and second deposit or full payment) The remaining balance will be charged automatically on the days specified.)
I would like a payment plan after initial deposit. Please contact me with details.
CREDIT CARD INFORMATION : My credit card will be billed a deposit amount of $US immediately, to secure my reservation. Final payment is due as per payment schedule. E-mail confirmation will be sent.
CREDIT CARD NUMBER : *
EXPIRATION DATE : *
CARD HOLDER’S NAME : *
CVC # : * I am authorizing Meetings & Incentive Marketing – MIM Travel, the Cruise Line and/or Tour Operator, to automatically charge deposits, service fees, payments, insurance (if applicable), flight arrangements (if applicable) and cancellation fees, to my credit card in accordance with the payment schedule and cancellation policy.
ADDRESS, If different from Home address:
2nd CREDIT CARD INFORMATION : If an additional credit card is supplied, then all charges will be split evenly, unless alternate payment instructions are provided in the comment section of this form.
CREDIT CARD NUMBER :
EXPIRATION DATE :
CARD HOLDER’S NAME :
CVC # : I am authorizing Meetings & Incentive Marketing – MIM Travel, the Cruise Line and/or Tour Operator, to automatically charge deposits, service fees, payments, insurance (if applicable), flight arrangements (if applicable) and cancellation fees, to my credit card in accordance with the payment schedule and cancellation policy.
ADDRESS, If different from Home address:

OTHER SERVICES AND RESERVATONS
Please tell us if you need Hotel reservations, car rental, transfers, etc.
AIRLINE FLIGHT RESERVATONS:
Arrange my flights?
No, I will arrange my own fights (If checked, ignore rest of Airline Flight Section Yes, please send me a quote for Airfare
Class : Economy
Business Class First Class
Gateway City :
(Enter departure A/P City or Code)
Departure Date : Departure Time :
Return Date : Return Time :
* I agree to the Tour Operator (Meetings & Incentive Marketing – MIM Travel) and all it’s suppliers - TERMS AND CONDITIONS

ELECTRONIC SIGNATURE/AUTHORIZATION
I verify that I am at least 21 years of age. I have read the Terms and Conditions and acknowledge that I have been offered travel insurance.
Passenger 1 : * Date : *
Passenger 2 : Date :
EXTRA INFORMATION : *
Where did you hear about us?
Comments Box :
NOTE : Your reservation is not confirmed until we have provided you with a booking number by phone or email.

Please print this completed form for your records before hitting the “SUBMIT” button.
   

GAY TRAVEL BY MIM.COM is a registered website of Meetings and Incentive Marketing – MIM Travel. All prices, availability and itineraries are subject to change without prior notice. Reservations are subject to availability. GayTravelbyMIM.com, Meetings & Incentive Marketing and MIM Travel are registered trademarks and cannot be used without the expressed written permission of MIM Travel. Reservations made on this website are subject to the terms and conditions as outlined by MIM Travel, on the respective reservation forms.